MRI-Guided Cardiac Catheterization in Congenital Heart Disease: How to Get Started

Abstract

Purpose of Review Cardiac magnetic resonance imaging provides radiation-free, 3-dimensional soft tissue visualization with adjunct hemodynamic data, making it a promising candidate for image-guided transcatheter interventions. This review focuses on the benefits and background of real-time magnetic resonance imaging (MRI)-guided cardiac catheterization, guidance on starting a clinical program, and recent research developments. Recent Findings Interventional cardiac magnetic resonance (iCMR) has an established track record with the first entirely MRI-guided cardiac catheterization for congenital heart disease reported nearly 20 years ago. Since then, many centers have embarked upon clinical iCMR programs primarily performing diagnostic MRI-guided cardiac catheterization. There have also been limited reports of successful real-time MRI-guided transcatheter interventions. Growing experience in performing cardiac catheterization in the magnetic resonance environment has facilitated practical workflows appropriate for efficiency-focused cardiac catheterization laboratories. Most exciting developments in imaging technology, MRI-compatible equipment and MRI-guided novel transcatheter interventions have been limited to preclinical research. Many of these research developments are ready for clinical translation. Summary With increasing iCMR clinical experience and translation of preclinical research innovations, the time to make the leap to radiation-free procedures is now.

Low‐field MRI: Clinical promise and challenges

“…7 ). 22 , 133 Synaptive Medical offers the 0.5T Evry system, which was designed for iMRI applications. Preliminary studies report reduced risk of RF‐induced heating and have demonstrated gradient specifications (max amplitude = 100 mT/m, max slew = 400 T/m/sec) that enable high‐quality diffusion tensor imaging.…”

Associated radiation exposure from medical imaging and excess lifetime risk of developing cancer in pediatric patients with pulmonary hypertension

“…Current guidelines recommend obtaining CT angiography and cardiac catheterization to evaluate the etiology of PH, assess severity of the disease, and guide treatment decisions 20 . However, magnetic resonance imaging (MRI) and interventional cardiac magnetic resonance catheterizations provide alternatives to CT and fluoroscopy that do not use ionizing radiation 21,22 . In addition to providing diagnostic information, MRI can provide additional hemodynamic information.…”

“… 20 However, magnetic resonance imaging (MRI) and interventional cardiac magnetic resonance catheterizations provide alternatives to CT and fluoroscopy that do not use ionizing radiation. 21 , 22 In addition to providing diagnostic information, MRI can provide additional hemodynamic information. The downside of MRI is that it usually requires longer scan time, necessitating sedation.…”

Real‐time automatic image‐based slice tracking of gadolinium‐filled balloon wedge catheter during MR‐guided cardiac catheterization: A proof‐of‐concept study

“…MRI is an attractive alternative to X-ray fluoroscopy for the guidance of cardiac catheterization procedures, [4][5][6][7][8][9][10][11][12][13][14][15][16] as it not only avoids exposure to harmful ionizing radiation especially undesirable in young patients undergoing repeat procedures, 17,18 but also offers high soft-tissue contrast, superior hemodynamic data, easy manipulation of the imaging planes, and real-time 3D acquisition and reconstruction of complex anatomy. 11,[19][20][21] Passive tracking approaches are currently used clinically for real-time visualization of the catheter during MR guidance. [4][5][6][8][9][10][11][12][14][15][16]22 These approaches commonly use balloon wedge catheters, which can be filled with CO 2 for negative contrast visualization (hypo-intense signal) or diluted Gadolinium (Gd) for positive contrast visualization (hyperintense signal) in the images.…”

“…MRI is an attractive alternative to X‐ray fluoroscopy for the guidance of cardiac catheterization procedures, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 as it not only avoids exposure to harmful ionizing radiation especially undesirable in young patients undergoing repeat procedures, 17 , 18 but also offers high soft‐tissue contrast, superior hemodynamic data, easy manipulation of the imaging planes, and real‐time 3D acquisition and reconstruction of complex anatomy. 11 , 19 , 20 , 21 …”